Association between depression and bone mineral density in community-dwelling older men and women in Korea

The association between depression and bone metabolism: a US nationally representative cross-sectional study

This population-based study investigated the association between depression and bone mineral density (BMD), fractures, and osteoporosis in the US population. We found that participants with depression had lower BMD and were more likely to have fractures and osteoporosis.

BACKGROUND

Depression, fractures, and osteoporosis are common in middle-aged and elderly, but their associations remained unclear.

OBJECTIVE

To investigate the association between depression and bone mineral density (BMD), osteoporosis, and fracture in a middle-aged and elderly US population.

METHODS

A nationally representative cross-sectional study used the National Health and Nutrition Examination Survey (NHANES) datasets. Depression was assessed and stratified using the Patient Health Questionnaire (PHQ-9). The multiple logistic regression models and the logistic binary regression models were used to analyze the association between depression and BMD, fractures, and osteoporosis. Gender, age, race, educational level, poverty ratio, body mass index (BMI), smoke, alcohol use, physical activity, and diabetes were included as covariates. Subgroup analysis was also conducted on gender, age, race, and education level.

RESULTS

In total, 9766 participants were included after a series of exclusions, and 4179 (42.79%) had at least mild depressive symptoms. Compared to the participants without depression, those with depression had a lower total femur, femoral neck, and total spine BMD after adjusting multiple covariates. The multivariable-adjusted logistic binary regression models demonstrated that participants with depression more likely have hip fractures (OR = 1.518, 95% CI: 1.377-2.703, P = 0.000), spine fractures (OR = 1.311, 95% CI: 1.022-1.678, P = 0.030), and osteoporosis (OR = 1.621, 95% CI: 1.388-1.890, P = 0.000). Subgroup analysis revealed that depressed participants who were males, non-Hispanic White, ≤ 70 years, and not highly educated had a lower BMD and easily had osteoporosis.

CONCLUSION

Depression was associated with lower BMD, particularly in the spine, males, Hispanic-White, and not highly educated populations. Moreover, people with depression were more likely to have fractures and osteoporosis.

The relationship between osteoporosis and depression

Osteoporosis is the most common metabolic bone disease. The complications of osteoporosis have influence on people's lives and lead to anxiety and depression. The aim of this study was to determine the relationship between osteoporosis and depression among Iranian patients. This cross-sectional analytical survey study conducted among 500 patients referred to a Bone Densitometry Center in Iran. They were assigned into with osteoporosis group (n = 250) and non-affected group (n = 250). The Persian version of the 13-item Beck Depression Inventory (BDI) was used to assess depression. ANOVA, independent t-test, chi-square were used to compare the data. All analyses were done using SPSS version 22 software. A P value ≤ 0.05 represented statistical significance. The majority of people with osteoporosis (86.9%), suffered from mild to moderate depression and the majority of normal people (84.6%) were non-depressed. The mean scores (SD) of depressions in the patients with osteoporosis and normal status was 6.94 (2.39) and 2.50 (1.01), respectively. Statistical analyses showed that the mean scores of depressions significantly different between the two groups (P < 0.05). The results indicate that depression is associated with osteoporosis. As a result, physicians are expected to pay attention to depression in people with osteoporosis and to treat it.

Depression, Quality of Life, and Self-Esteem of Moroccan Postmenopausal Women with Osteoporosis before the Occurrence of Fractures

Objectives

Previous researches have investigated depression in postmenopausal women (PMW) with osteoporosis and fractures, but little is known regarding Moroccan PMW without fractures. We investigated depression prevalence and severity in Moroccan PMW with osteoporosis without fractures and its relationship with quality of life (QoL) and physical and psychological state.

Methods

This cross-sectional study enrolled 100 PMW with osteoporosis without fractures. Depressive symptoms, QoL, self-esteem, and fatigue were evaluated using the Patient Health Questionnaire-9 (PHQ-9), Arabic version of ECOS-16 questionnaire, Rosenberg self-esteem scale, and Arabic version of the Multidimensional Assessment of Fatigue scale, respectively. A questionnaire including sociodemographic factors, bone density features, pain intensity, and sleep disturbance was completed.

Results

Overall, 58% patients suffered from depression and 55% from pain (63.8% depressed women vs. 42.9% nondepressed patients; P = 0.03). Bone mineral density, lumbar spine T-score, ECOS-16, and self-esteem in depressed and nondepressed women were 0.791 (0.738–0.840) vs. 0.835 (0.790–0.866); −3.25 (−3.8 to −2.875) vs. −2.9 (−3.425 to −2.700), P = 0.02; 2.338 ± 0.605 vs. 1.638 ± 0.455; and 13.517 ± 5.487 vs. 18.404 ± 5.771, P < 0.0001, respectively. Depression severity correlated with pain, QoL, self-esteem, and fatigue (r = 0.367, r = −0.390, r = −0.390, and r = 0.369, respectively; P < 0.0001) as well as lumbar spine bone mineral density and T-score (r = −0.258 and r = −0.255, respectively; P = 0.01). Multiple linear regression analysis revealed impaired QoL (β = 0.526; P < 0.0001), fatigue (β = 0.177; P = 0.02), and lower self-esteem (β = −2.170; P = 0.005) as the strongest risk factors of depression.

Conclusions

Our study shows that even without fractures, Moroccan PMW with osteoporosis suffered from depression, pain, impaired QoL, and lower self-esteem.

Acute ketamine administration corrects abnormal inflammatory bone markers in major depressive disorder

Patients with major depressive disorder (MDD) have clinically relevant, significant decreases in bone mineral density (BMD). We sought to determine if predictive markers of bone inflammation-the osteoprotegerin (OPG)-RANK-RANKL system or osteopontin (OPN)-play a role in the bone abnormalities associated with MDD and, if so, whether ketamine treatment corrected the abnormalities. The OPG-RANK-RANKL system plays the principal role in determining the balance between bone resorption and bone formation. RANKL is the osteoclast differentiating factor and diminishes BMD. OPG is a decoy receptor for RANKL, thereby increasing BMD. OPN is the bone glue that acts as a scaffold between bone tissues matrix composition to bind them together and is an important component of bone strength and fracture resistance. Twenty-eight medication-free inpatients with treatment-resistant MDD and 16 healthy controls (HCs) participated in the study. Peripheral bone marker levels and their responses to IV ketamine infusion in MDD patients and HCs were measured at four time points: at baseline, and post-infusion at 230 min, Day 1, and Day 3. Patients with MDD had significant decreases in baseline OPG/RANKL ratio and in plasma OPN levels. Ketamine significantly increased both the OPG/RANKL ratio and plasma OPN levels, and significantly decreased RANKL levels. Bone marker levels in HCs remained unaltered. We conclude that the OPG-RANK-RANKL system and the OPN system play important roles in the serious bone abnormalities associated with MDD. These data suggest that, in addition to its antidepressant effects, ketamine also has a salutary effect on a major medical complication of depressive illness.

Depressive symptoms and bone mineral density in menopause and postmenopausal women: A still increasing and neglected problem

Background:

The association between depression and loss of bone mineral density (BMD) has been reported as controversial.

Objective:

The objectıve of the current study was to investigate whether an association exists between depression and low BMD during the menopausal and postmenopausal period.

Materials and Methods:

A cross-sectional descriptive study was used to generate menopause symptoms experienced by Arabian women at the Primary Health Care Centers in Qatar. A multi-stage sampling design was used, and a representative sample of 1650 women aged 45–65 years were included during July 2012 and November 2013. This prospective study explored the association between bone density and major depressive disorder in women. Bone mineral densitometry measurements (BMD) (g/m²) were assessed at the BMD unit using a lunar prodigy DXA system (Lunar Corp., Madison, WI). Data on body mass index (BMI), clinical biochemistry variables including serum 25-hydroxyvitamin D were collected. The Beck Depression Inventory was administered for depression purposes.

Results:

Out of 1650 women 1182 women agreed to participate in the study (71.6%). The mean age and standard deviation (SD) of the menopausal age were 48.71 ± 2.96 with depressed and 50.20 ± 3.22 without depressed (P < 0.001). Furthermore, the mean and SD of postmenopausal age were 58.55 ± 3.27 with depression and 57.78 ± 3.20 without depression (P < 0.001). There were statistically significant differences between menopausal stages with regards to a number of parity, and place of living. There were statistically significant differences between menopausal stages with regards to BMI, systolic and diastolic blood pressure, Vitamin D deficiency, calcium deficiency and shisha smoking habits. Overall, osteopenia and osteoporosis and bone loss were significantly lower in postmenopausal women than in menopausal women (P < 0.001). Similarly, T-score and Z-score were lower with depression menopause and postmenopausal women (P < 0.001). The multivariate logistic regression analyses revealed that the depression, the mean serum Vitamin D deficiency, calcium level deficiency, less physical activity, comorbidity, number of parity, systolic and diastolic blood pressure and shisha smoking habits were considered as the main risk factors associated with bone mineral loss after adjusting for age, BMI and other variables.

Conclusion:

Depression is associated with low BMD with a substantially greater BMD decrease in depressed women and cases of clinical depression. Depression should be considered as an important risk factor for osteoporosis.

Low vitamin D, and bone mineral density with depressive symptoms burden in menopausal and postmenopausal women

BACKGROUND

The reported association between vitamin D level and loss of Bone mineral densitometry measurements (BMD) has been controversial.

OBJECTIVE

The objectıve of the current study was to determine whether low vitamin D level and BMD are associated with depresive symptoms as burden in Arab women during the menopausal and postmenopausal period.

DESIGN AND SETTING

A cross-sectional descriptive study design was used at the Primary Health Care (PHC) Centers in Qatar.

SUBJECTS

A multi-stage sampling design was used and a representative sample of 1436 women aged 45-65 years were included during July 2012 and November 2013 and 1106 women agreed to participate (77.2%) and responded to the study.

MATERIALS AND METHODS

BMD (g/m(2)) was assessed at the BMD unit using a Lunar Prodigy DXA system (Lunar Corp., Madison, WI). The antero-posterior lumbar spine (L2-L4) and the mean of the proximal right and left femur were be measured by two technician and then reviewed by one radiologist. Data on body mass index (BMI), clinical biochemistry variables including serum 25-hydroxyvitamin D were collected. The Beck Depression Inventory (BDI) was administered for depression purposes.

RESULTS

Of the 1436 women living in urban and rural areas, 1106 women agreed to participate (77.0%) and responded to the study. The mean age and standard deviation of the subjects was 53.8 ± 3.2. The median age of natural menopausal in the present study was 49 years (mean and standard deviation 49.5 ± 3.1 and postmenopausal was 58.1 ± 3.3). There were statistically significant differences between menopausal stages with regards to ethnicity, education level, systolic and dialostic blood pressure, parity, sheesha smoking and depressive symptoms. Overall 30.4% of women were affected with osteopenia/osteoporosis in premenopausal and postmenopausal (24.4% vs 35.7%; P = 0.0442). Osteopenia in premenopausal and postmenopausal (18.7% vs 29.3%; P = 0.030) and Osteoporosis (9.9% vs 15.9%; P = 0.049) were significantly higher in post-menopausal women than in premenopausal women (P = 0.046). Similarly, vitamin D deficiency was more prevalent among postmenopausal women than menopausal women. Overall, only 15.1% of women had optimum vitamin D level and 15.5% had severe, 33.2% had moderate vitamin D insufficiency and 36.3% had mild vitamin D insufficiency in menopausal and post menopausal women (P = 0.021). The study revealed that vitamin D level, hemoglobin level, serum iron fasting plasma glucose, calcium, triglycerides, high density lipid (HDL) cholesterol, low density lipid (LDL) Cholesterol, alkaline phosphate and magnesium were considerably lower in postmenopausal compared to menopausal women (P < 0.001).

CONCLUSION

The current study revealed that there was a strong association between vitamin D level and BMD in Arab women during the menopausal and post-menopausal period.

Increased risk of osteoporosis in patients with depression: a population-based retrospective cohort study

OBJECTIVE

To investigate the relationship between depression and risk of subsequent osteoporosis development.

PARTICIPANTS AND METHODS

A population-based retrospective cohort analysis was conducted using the Longitudinal Health Insurance Database 2000 of Taiwan. We included 32,978 patients in the depression cohort and 131,912 patients in the no-depression cohort between January 1, 1998, and December 31, 2008, and calculated the incidence rates of newly diagnosed osteoporosis. We used Cox proportional hazards models to assess the effects of depression. The Kaplan-Meier method was applied to estimate the cumulative osteoporosis incidence curves.

RESULTS

Patients with depression were 1.30 times more likely to experience osteoporosis than those without depression. The risk was higher for patients with severe depression and mild depression than for those without depression. A greater hazard ratio magnitude was observed in patients aged 35 to 49 years. We also observed a significant decrease in osteoporosis risk in patients with depression treated with antidepressant agents.

CONCLUSION

The incidence of osteoporosis in Taiwan is associated with an a priori depression history. The risk was identified in both men and women, particularly in patients aged 35 to 49 years, and was inversely correlated with antidepressant drug treatment.

Association between serum 25-hydroxyvitamin D level and insulin resistance in a rural population

PURPOSE

A low serum 25-hydroxyvitamin D [25(OH)D] level in the blood has been correlated with an increased risk of diabetes mellitus; however, the association between serum 25(OH)D level and insulin resistance has not been established in a Korean rural population. The aim of this study was to investigate the independent association between serum 25(OH)D level and insulin resistance in rural Korean adults.

MATERIALS AND METHODS

This study used data from the Korean Genome Epidemiology Study-Kangwha Study. In the 2011 study, 1200 adults completed health examinations. In an ancillary study, serum 25(OH)D level was measured in a subsample (n=813). After excluding those taking vitamin D supplements, a cross-sectional analysis was carried out on 807 participants (324 men and 483 women) aged 40 to 89 years old. Measured from overnight fasting blood samples, glucose and insulin levels were used to calculate the homeostasis model assessment for insulin resistance (HOMA-IR). Measures of glucose, insulin, and HOMA-IR were log-transformed for parametric tests.

RESULTS

Serum 25(OH)D level was inversely associated with HOMA-IR (β=-0.003, p=0.039) in a univariate analysis. However, the association was not significant after adjustment for sex and age (β=-0.002, p=0.123) or after adjustment for sex, age, body mass index, smoking status, alcohol intake, and regular exercise (β=-0.003, p=0.247).

CONCLUSION

Our findings suggest that vitamin D is not independently associated with insulin resistance in Korean men and women.

Association between depressive symptoms and bone stiffness index in young adults: the Kangwha study

OBJECTIVE

Young adulthood is an important period for both bone and mental health. This study investigated the association between depressive symptoms and bone density in apparently healthy Korean men and women aged 29-32 years.

METHODS

This study is a cross-sectional analysis of data from 123 men and 133 women who completed follow-up examinations of the Kangwha study in 2010-2011. Bone stiffness index (SI) was measured at the os calcis using a quantitative ultrasound device. Depressive symptoms were evaluated using the Korean version of the Beck Depression Inventory (K-BDI) and classified as normal (K-BDI <10), mild (K-BDI 10-15), and moderate to severe (K-BDI ≥16).

RESULTS

Moderate to severe depressive symptoms were prevalent among 11.4% of men and 19.6% of women. Higher K-BDI scores were significantly correlated to SI in men, before (ρ = -0.286, p = 0.001) and after (ρ = -0.228, p = 0.013) adjustment for covariates. Men with depressive symptoms tended to have a lower SI; multivariate-adjusted mean SI in men with normal, mild, and moderate to severe depressive symptoms was 104.1±3.1, 100.9±5.9, and 94.1±7.8, respectively (p for trend = 0.021). In contrast, no significant correlations were identified in women.

CONCLUSIONS

Depressive symptoms were significantly associated with lower SI in men, but not in women. Further studies are necessary to evaluate the impact of depression on developing osteoporosis or osteoporotic fractures later in life.

The "depressive" face of osteoporosis and the "osteoporotic" face of depression

Osteoporosis and depression are two chronic diseases that affect large population groups with great impact on morbidity, mortality and quality of life. An association between osteoporosis and depression has been described in the literature. Definitely, limited data suggest that osteoporosis may enhance depressive symptoms, while far more studies have shown that depression adversely affects bone density and increases fracture risk. However, neither causation nor a firm pathophysiological connection has been established. Thus the correlation of these diseases is still under research. This review comments on a plausible causative relationship and underlying mechanisms that might elucidate the link between two very common diseases. We describe the possible impact of osteoporosis on moods and the (better established) effect of depression on bone health. We also describe the effect of medication and review hormonal and cellular signals that may explain this effect.

Quantitative Heel Ultrasound (QUS) measures of bone quality in association with mood and anxiety disorders

BACKGROUND

The common mental disorders are potential risk factors for low bone mass as a result of disease and/or medication-related processes. Quantitative heel ultrasound (QUS) is a portable and relatively cheap screening tool for determining fracture risk. Thus, we investigated the association between QUS parameters, mood and anxiety disorders in a population-based sample of 745 men and 897 women.

METHODS

Using a clinical interview (SCID-I/NP), mood and anxiety disorders were identified. Bone quality was established using QUS and included the following parameters: Broadband Ultrasound Attenuation (BUA), Speed of Sound (SOS) and Stiffness Index (SI). Anthropometry, socio-economic status (SES), medication use and lifestyle factors were determined.

RESULTS

In men, mood and anxiety disorders were associated with lower age-weight- and smoking-adjusted SOS, BUA and SI. In women, age was an effect modifier. Among younger women (≤ 40yr), mood disorders were associated with lower age-weight- and smoking-adjusted SOS and SI but not BUA. No differences were detected in older women or women with anxiety disorders. These patterns persisted after adjustment for activity, alcohol, calcium intake, SES and medications.

LIMITATIONS

Cross-sectional study design, and possible residual or unrecognised confounding.

CONCLUSION

Our data suggest that bone quality, as measured by QUS, is reduced among men and younger women with a history of mood disorders. Furthermore, an inverse association between anxiety disorders and bone quality was evident for men. Thus, QUS may be a useful screening tool for determining fracture risk within these populations.